The PROMISES study: a mixed methods approach to explore the acceptability of salivary progesterone testing for preterm birth risk among pregnant women and trained frontline healthcare workers in rural India

Abstract

IntroductionIndia has an overall neonatal mortality rate of 28/1000 live births, with higher rates in rural India. Approximately 3.5 million pregnancies in India are affected by preterm birth (PTB) annually and contribute to approximately a quarter of PTBs globally. Embedded within the PROMISES study (which aims to validate a low-cost salivary progesterone test for early detection of PTB risk), we present a mixed methods explanatory sequential feasibility substudy of the salivary progesterone test.MethodsA pretraining and post-training questionnaire to assess Accredited Social Health Activists (ASHAs) (n=201) knowledge and experience of PTB and salivary progesterone sampling was analysed using the McNemar test. Descriptive statistics for a cross-sectional survey of pregnant women (n=400) are presented in which the acceptability of this test for pregnant women is assessed. Structured interviews were undertaken with ASHAs (n=10) and pregnant women (n=9), and were analysed using thematic framework analysis to explore the barriers and facilitators influencing the use of this test in rural India.ResultsBefore training, ASHAs’ knowledge of PTB (including risk factors, causes, postnatal support and testing) was very limited. After the training programme, there was a significant improvement in the ASHAs’ knowledge of PTB. All 400 women reported the salivary test was acceptable with the majority finding it easy but not quick or better than drawing blood. For the qualitative aspects of the study, analysis of interview data with ASHAs and women, our thematic framework comprised of three main areas: implementation of intervention; networks of influence and access to healthcare. Qualitative data were stratified and presented as barriers and facilitators.ConclusionThis study suggests support for ongoing investigations validating PTB testing using salivary progesterone in rural settings.

Salivary progesterone as a biomarker for predicting preterm birth: A systematic review and meta‐analysis

“…23 As of date, the most common method to measure it is via ELISA, an assay that is increasing in utilization even in developing countries since several samples can be run per batch which lessens the cost of the test. Importantly, the method was found to be acceptable to pregnant women and community health workers alike as seen in the study by Ashworth et al 24 in rural India that explored the acceptability of salivary progesterone testing. Both quantitative and quantitative data showed that the health workers and pregnant women perceived the intervention as acceptable with no issues in relation to its usefulness and feasibility.…”

Audio Diaries: A Novel Method for Water, Sanitation, and Hygiene-Related Maternal Stress Research

“…However, it is important to remember that the audio diary prompts focused on ordinary activities with little attention to emotion, while the interviews specifically asked women to reflect on their experience of making audio diaries, eliciting some of the reasons (e.g., lack of privacy to record) that interfered with their ability or desire to record. This feasibility study demonstrates that even when asking impersonal questions, audio diaries can bridge the public-private divide between investigators and participants, including those related to domestic conflict and stressful experiences, through trust-building over the course of the recording period, and through the integration of local health care workers throughout the process (Ashworth et al, 2021).…”

“…Given that our prompts asked women rather mundane questions about everyday experiences, it is notable that women did speak about their experiences making recordings in ways that revealed their feelings about them. Support and encouragement from the field team over the two weeks of recording were key to the trust-building (Ashworth et al, 2021) that elicited important reflections and women's continuing participation.…”

“…Participants were more open during the exit interview than in their audio diary entries, perhaps because three weeks was the time necessary to establish trust (Ashworth et al, 2021) or because the field team strengthened participants’ ability to carefully examine their own situation. However, it is important to remember that the audio diary prompts focused on ordinary activities with little attention to emotion, while the interviews specifically asked women to reflect on their experience of making audio diaries, eliciting some of the reasons (e.g., lack of privacy to record) that interfered with their ability or desire to record.…”